Aa
Advice needed
Hi everyone,
I am new to this forum and I am hoping that someone can give me some advice.
These are my last few labs. After my dr. received the August one she said that I should stay on the same dose. I was thinking of adding a little more cytomel since my Free T3 is still on the low side. If I do, should I lower my Synthroid again? I would appreciate any advice.
August
Synthroid 75 Cytomel 5 twice a day.
t4,free(direct) 1.08 0.82-1.77 ng/dL
tsh 3.010 0.450-4.500 uIU/mL
triiodothyronine,free,serum 2.7 2.0-4.4 pg/mL
reverse t3, serum 15.0 9.2-24.1 ng/dL
June
Synthroid - 75/88 Cytomel - 5 split into 2 doses.( am and early afternoon)
t4,free(direct) 1.56 0.82-1.77 ng/dL
tsh 7.650 0.450-4.500 uIU/mL
triiodothyronine,free,serum 2.3 2.0-4.4 pg/mL
vitamin d, 25-hydroxy 53.5 30.0-100.0 ng/mL
vitamin b12 546 211-946 pg/mL
April
Synthroid 88 Cytomel 5 split into 2 doses (am and early afternoon)
tsh 9.470 0.450-4.500 uIU/mL
t4,free(direct) 1.55 0.82-1.77 ng/dL
triiodothyronine,free,serum 2.5 2.0-4.4 pg/mL
reverse t3, serum 14.9 9.2-24.1 ng/dL
February
Synthroid 88/100
tsh 9.470 0.450-4.500 uIU/mL
t4,free(direct) 1.55 0.82-1.77 ng/dL
triiodothyronine,free,serum 2.5 2.0-4.4 pg/mL
reverse t3, serum 14.9 9.2-24.1 ng/dL
10/21/2010Thyroid Peroxidase -68 H < 35
10/22/2012 - thyroid ultrasound - Thyroid is heterogenous but no distinct nodules are identified. The appearance is consistent Hasimotos's Thyroiditis.
Thanks,
Bessie
I am new to this forum and I am hoping that someone can give me some advice.
These are my last few labs. After my dr. received the August one she said that I should stay on the same dose. I was thinking of adding a little more cytomel since my Free T3 is still on the low side. If I do, should I lower my Synthroid again? I would appreciate any advice.
August
Synthroid 75 Cytomel 5 twice a day.
t4,free(direct) 1.08 0.82-1.77 ng/dL
tsh 3.010 0.450-4.500 uIU/mL
triiodothyronine,free,serum 2.7 2.0-4.4 pg/mL
reverse t3, serum 15.0 9.2-24.1 ng/dL
June
Synthroid - 75/88 Cytomel - 5 split into 2 doses.( am and early afternoon)
t4,free(direct) 1.56 0.82-1.77 ng/dL
tsh 7.650 0.450-4.500 uIU/mL
triiodothyronine,free,serum 2.3 2.0-4.4 pg/mL
vitamin d, 25-hydroxy 53.5 30.0-100.0 ng/mL
vitamin b12 546 211-946 pg/mL
April
Synthroid 88 Cytomel 5 split into 2 doses (am and early afternoon)
tsh 9.470 0.450-4.500 uIU/mL
t4,free(direct) 1.55 0.82-1.77 ng/dL
triiodothyronine,free,serum 2.5 2.0-4.4 pg/mL
reverse t3, serum 14.9 9.2-24.1 ng/dL
February
Synthroid 88/100
tsh 9.470 0.450-4.500 uIU/mL
t4,free(direct) 1.55 0.82-1.77 ng/dL
triiodothyronine,free,serum 2.5 2.0-4.4 pg/mL
reverse t3, serum 14.9 9.2-24.1 ng/dL
10/21/2010Thyroid Peroxidase -68 H < 35
10/22/2012 - thyroid ultrasound - Thyroid is heterogenous but no distinct nodules are identified. The appearance is consistent Hasimotos's Thyroiditis.
Thanks,
Bessie
T3 has a half life of less than a day, so that means that it will be full reflected in serum levels in about 5 days. So two weeks is plenty to wait for a re=test of serum levels. Be aware though that symptom changes tend to lag somewhat behind changes in serum levels of Free T4 and Free T3. So, as you approach optimal levels, you may need to allow more time between dose increases in order to determine the effect on symptoms.
How long do I have to wait to have blood tests done after increasing Cytomel.? I increased them about 2 weeks ago and wanted to see if I should increase them again but I thought maybe I should get new FreeT3 's first.
Following is a quote from a good thyroid doctor.
"The TSH level tells us nothing about the physiology of a person on thyroid replacement therapy. In tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT."
Many members here also say that symptom relief required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as necessary to relieve symptoms. At 1.08 your Free T4 is only at 27% of its range, and your Free T3 is only at 29% of its range. So you are a long way from being optimal on both of those.
In addition, hypo patients are frequently to low in the ranges for Vitamin D, B12 and ferritin. That is because of low stomach acid that does not provide good absorption of vitamins and nutrients. D should be about 55-60, B12 in the upper end of its range and ferritin should be about 70 minimum.
So you should get the doctor to test for those 3 and then supplement as needed to optimize. You also need to get your doctor to gradually increase your meds to reach the levels needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results.
One thing more. Defer taking your morning T3 med until after the blood draw for tests. T3 acts so fast that it can cause false high results that might cause your doctor to react the wrong way regarding further med increases.
"The TSH level tells us nothing about the physiology of a person on thyroid replacement therapy. In tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT."
Many members here also say that symptom relief required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range, or as necessary to relieve symptoms. At 1.08 your Free T4 is only at 27% of its range, and your Free T3 is only at 29% of its range. So you are a long way from being optimal on both of those.
In addition, hypo patients are frequently to low in the ranges for Vitamin D, B12 and ferritin. That is because of low stomach acid that does not provide good absorption of vitamins and nutrients. D should be about 55-60, B12 in the upper end of its range and ferritin should be about 70 minimum.
So you should get the doctor to test for those 3 and then supplement as needed to optimize. You also need to get your doctor to gradually increase your meds to reach the levels needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results.
One thing more. Defer taking your morning T3 med until after the blood draw for tests. T3 acts so fast that it can cause false high results that might cause your doctor to react the wrong way regarding further med increases.
My main complaint is fatigue. I feel a little better after adding the Cytomel . I had to add it slowly because it made me jittery at first .I am in my 60's but I live in an active adult community and I am involved in many activities. I have to push myself to go to water aerobic, dance etc. Most of the time I would rather just sit at home but that's not me.
Bessie
Bessie
Before discussing changes to your meds, we need to consider any symptoms that you have. Please tell us about those.
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